[Impact of psychiatric disorders on the outcome of acute geriatric inpatient treatment: an exploratory investigation]. / Die Bedeutung psychischer Störungen für den stationär akutgeriatrischen Behandlungsverlauf: eine explorative Untersuchung.

BACKGROUND: Systematic study results of geriatric inpatient treatment assessing the impact of psychiatric disorders on treatment outcome are so far missing. This exploratory study investigated the impact of dementia, depression and delirium on treatment outcome in a geriatric department, compared to those individuals without psychiatric symptoms at the beginning of treatment. METHOD: From January to June 2018 treatment data from geriatric inpatient records were retrospectively evaluated. Functional measurements (Barthel index, timed up and go test, Tinetti test and the De Morton mobility index) were assessed at the start of geriatric treatment and at discharge. A multivariate variance analysis (MANOVA) was used to calculate the possible impact of psychiatric disorders on functional improvement during treatment and to find out if there were significant differences between the four defined groups (dementia, depression, delirium and mentally sound). RESULTS: A total of 280 geriatric inpatients with an average age of 84 years, were included in this study and showed a noticeable prevalence of psychiatric disorders: dementia 29%, depression 27%, and delirium 15%. As expected, the patients in the sample showed a high level of multimorbidity and polypharmacy. Functional improvement was present in each of the defined groups and significant differences between all groups were found. The results of MANOVA showed that none of the possible confounding variables, e.g. age, mini mental status examination (MMSE), degree of care, cognitive impairment, social status, gender and comorbid illness, had an important influence on the group results. CONCLUSION: This study of an acute geriatric department demonstrated that psychiatric disorders in these multimorbid, aged patients did not prevent functional improvement by treatment, showed significant differences during the course of treatment and outcome and compared to inpatients without psychiatric symptoms.

Modular life cycle assessment of municipal solid waste management.

Life cycle assessment (LCA) is commonly applied to examine the environmental performance of waste management systems. The system boundaries are, however, often limited to either one tonne of material or to specific waste treatments and are, therefore, lacking a systems perspective. Here, a framework is proposed to assess complete waste management systems based on actual waste flows, assessed with a detailed material flow analysis (MFA) in a modular MFA/LCA approach. The transformation of the MFA into a product-process-matrix facilitates a direct link between MFA and LCA, therefore allowing for the assessment of variations in flows. To allow for an up-to-date and geographically specific assessment, 190 LCA modules were set up based on primary industrial data and the ecoinvent database. The LCA modules show where there have been improvements in different recycling processes over the past years (e.g. for paper recycling) and highlight that, from an environmental perspective, closed-loop recycling is not always preferable to open-loop recycling. In a case study, the Swiss municipal solid waste management system, of which there is already a detailed MFA, was modeled using the new LCA modules and applying the modular MFA/LCA approach. Five different mass flow distribution scenarios for the Swiss municipal solid waste management system were assessed to show the environmental impact of political measures and to test the sensitivity of the results to key parameters. The results of the case study highlight the importance of the dominant fractions in the overall environmental impacts assessment; while the metal fraction has the highest impact on a per kilogram basis, paper, cardboard, glass and mixed municipal solid waste were found to dominate the environmental impacts of the Swiss waste management system due to their mass. The scenarios also highlight the importance of the energy efficiency of municipal solid waste incineration plants and the credits from material substitution as key variables. In countries with advanced waste management systems such as Switzerland, there is limited improvement potential with further increases in recycling rates. In these cases, the focus of political measures should be laid on (i) the utilization of secondary materials in applications where they replace high-impact primary production, and (ii) an increased recovery of energy in waste-to-energy plants.

[Willingness to participate in group beneficial dementia research]. / Bereitschaft zur Teilnahme an gruppennütziger Demenzforschung.

BACKGROUND: With the fourth Act on the amendment of pharmaceutical legal and other regulations it became law in Germany from the beginning of 2017 that under certain conditions, pharmaceutical research will be allowed with persons incapable of giving consent, even if this research may only be beneficial to other sufferers of the same disease, i. e. group beneficial research. OBJECTIVE: We conducted a semistructured, non-representative survey among psychiatric patients and their relatives. PARTICIPANTS AND METHODS: This survey was done for a period of 3 months until the end of September 2017 in the practice of M. H. with successively examined patients and their relatives. Patients incapable of giving consent related to dementia, depression and emergency cases, were excluded. Participants were asked about their attitudes related to evaluation of a) group beneficial research in principle, b) pharmaceutical withdrawal studies and c) research authorization. Sociodemographic and clinical variables were collected. RESULTS AND DISCUSSION: This study included 85 persons and all of them gave their informed consent to participation. The mean age was 70 years, 47% were male, 61% had a university degree and 46% an independent profession. Mild cognitive impairment was diagnosed in 26%. This survey revealed a relatively high basic approval of group beneficial dementia research as well as of pharmaceutical withdrawal studies. In addition, research authorization gained a substantially positive evaluation. Only a few participants were informed about the new law in force since 2017. The present results were drawn from an explorative study with an unrepresentative sample and, therefore, have to be interpreted with caution. They show, however, that in the general population more information and awareness about group beneficial research with persons incapable of giving informed consent should be achieved. The relatively high rate of approval in this study may reveal a widespread feeling of social responsibility; however, reported objections of the participants should also be seriously considered.

Is there an environmentally optimal separate collection rate?

Material recycling often leads to environmental benefits when compared to thermal treatments or landfilling and is therefore positioned in the waste hierarchy as the third priority after waste prevention and reuse. To assess the environmental impacts of recycling and the related substitution of primary material, linear steady-state models of physical flows are typically used. In reality, the environmental burdens of collection and recycling are likely to be a non-linear function of the collection rate. This short communication aims at raising awareness of the non-linear effects in separate collection systems and presents the first non-linear quantitative model for PET bottle recycling. The influence of collection rates on the material quality and the transport network is analyzed based on the data collected from industrial partners. The results highlight that in the present Swiss recycling system a very high collection rate close to 100% yields optimum environmental benefits with respect to global warming. The empirical data, however, provided indications for a decrease in the marginal environmental benefit of recycling. This can be seen as an indication that tipping points may exist for other recycling systems, in which the environmental benefits from substituting primary materials are less pronounced than they are for PET.

[Advance directive of probands in pharmaceutical research : A medical ethics discussion]. / Probandenverfügung in der Arzneimittelforschung : Eine medizinethische Diskussion.

In the fourth Act on the amendment of pharmaceutical legal and other regulations in November 2016, the legislature has designated the proband advance directive based on the instrument of patient advance directive to enable group beneficial research with persons not capable of giving consent. This article describes the existing conditional need for group beneficial research and presents the problem of the decisive instrument for advance directives at the center of the considerations. The features of the proband advance directive concluded by the legislature stand in opposition to a successful implementation, particularly due to the necessary concrete clarification content far in advance for informed research participants. This article describes solution possiblities, which refer to the realization of the instrument of a proxy research authorization as well as the consideration of an advance research planning based on the advance care planning.

[Overcoming disease in systemic lupus erythematosus]. / Krankheitsbewältigung bei systemischem Lupus erythematodes.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease affecting a broad range of different organ systems and, hence, presenting with multiple symptomatic domains, which considerably reduces the quality of life of patients. Within the last decade the prognosis of the disease has been significantly improved by novel therapies and intensive monitoring; however, non-pharmaceutical strategies for symptom control, self-efficacy and coping abilities for those affected are still insufficiently established. OBJECTIVE: This article describes the possibilities and limitations of non-pharmaceutical strategies and makes suggestions for future treatment and research. RESULTS: Preliminary interventional studies using psychoeducational, psychosocial and behavioral psychotherapeutic approaches, have consistently shown that the needs and expectations of patients related to help and support by doctors and professional care can be adequately and sustainably met. In addition, coping abilities and the quality of life can be increased.

Design and development of an injection-molded demultiplexer for optical communication systems in the visible range.

Optical simulation software based on the ray-tracing method offers easy and fast results in imaging optics. This method can also be applied in other fields of light propagation. For short distance communications, polymer optical fibers (POFs) are gradually gaining importance. This kind of fiber offers a larger core diameter, e.g., the step index POF features a core diameter of 980 µm. Consequently, POFs have a large number of modes (>3 million modes) in the visible range, and ray tracing could be used to simulate the propagation of light. This simulation method is applicable not only for the fiber itself but also for the key components of a complete POF network, e.g., couplers or other key elements of the transmission line. In this paper a demultiplexer designed and developed by means of ray tracing is presented. Compared to the classical optical design, requirements for optimal design differ particularly with regard to minimizing the insertion loss (IL). The basis of the presented key element is a WDM device using a Rowland spectrometer setup. In this approach the input fiber carries multiple wavelengths, which will be divided into multiple output fibers that transmit only one wavelength. To adapt the basic setup to POF, the guidance of light in this element has to be changed fundamentally. Here, a monolithic approach is presented with a blazed grating using an aspheric mirror to minimize most of the aberrations. In the simulations the POF is represented by an area light source, while the grating is analyzed for different orders and the highest possible efficiency. In general, the element should be designed in a way that it can be produced with a mass production technology like injection molding in order to offer a reasonable price. However, designing the elements with regard to injection molding leads to some inherent challenges. The microstructure of an optical grating and the thick-walled 3D molded parts both result in high demands on the injection molding process. This also requires complex machining of the molding tool. Therefore, different experiments are done to optimize the process parameter, find the best molding material, and find a suitable machining method for the molding tool. The paper will describe the development of the demultiplexer by means of ray-tracing simulations step by step. Also, the process steps and the realized solutions for the injection molding are described.

Lipid-based intravesical drug delivery systems with controlled release of trospium chloride for the urinary bladder.

The overactive bladder (OAB) is a common disease with an overactivity of the detrusor muscle in the bladder wall. Besides peroral administration of anticholinergic drugs and bladder irrigations, there is a need for a sustained release formulation in the urinary bladder. In order to realise a local long-term treatment of the overactive urinary bladder, lipidic drug delivery systems were prepared. Requirements for an intravesical application are a long-term controlled release of trospium chloride, a high drug loading and small sized drug carriers to permit an insertion through the urethra into the urinary bladder. The drug delivery systems were manufactured by using compression (mini-tablets), solid lipid extrusion (extrudates) and a melting and casting technique (mini-moulds) with different amounts of trospium chloride and glyceryl tristearate as matrix former. Drug release depended on the drug loading and the preparation method. Mini-tablets and lipidic extrudates showed a drug release over five days, whereas that from mini-moulds was negligibly small. The appearance of polymorphic transformations during processing and storage was investigated by using differential scanning calorimetry and X-ray diffraction. In contrast to mini-tablets and mini-moulds, lipidic extrudates showed no polymorphic transformations. In summary, lipids are suitable matrix formers for a highly water-soluble drug, like trospium chloride. Despite a drug loading of up to 30%, it was feasible to achieve a drug release ranging from several days up to weeks. In addition, small dosage forms with a size of only a few millimetres were realised. Therefore, an insertion and excretion through the urethra is possible and the requirements for an intravesical application are fulfilled.

Formation and photocatalytic decomposition of a pellicle on anatase surfaces.

The acquired dental pellicle plays a critical role in the adhesion and detachment of dental plaque bacteria. It has been reported that titanium dioxide biomaterials decompose single-protein films by photocatalysis. However, it is not known whether this can also be achieved with complex structured pellicle films. This in vitro study investigated in real-time the formation and photocatalytic decomposition of human pellicle at anatase-saliva interfaces. Nanostructured polycrystalline anatase layers were deposited on titanium-coated quartz crystals by magnetron-sputtering, serving as a model for titanium implant surfaces. The quartz crystals were used as acoustic sensors in a quartz-crystal microbalance (QCM) system with dissipation. In situ UV irradiation of pellicle-covered anatase caused a statistically significant decrease of the adsorbed salivary mass. In contrast, photocatalytic decomposition of pellicle could not be observed on reference titanium surfaces. Wettability characterization revealed superhydrophilicity of anatase upon UV irradiation, whereas titanium was unaffected. XPS measurements provide further information concerning the decomposition of the salivary films. The results suggest that the photocatalytic activity of polycrystalline anatase-modified biomaterial surfaces is able to decompose complex structured macromolecular pellicle films. Therefore, this study opens the way to surface modifications supporting therapeutic approaches of biofilm removal.

Multifunctional nature of UV-irradiated nanocrystalline anatase thin films for biomedical applications.

Anatase is known to decompose organic material by photocatalysis and to enhance surface wettability once irradiated by ultraviolet (UV) light. In this study, pulse magnetron-sputtered anatase thin films were investigated for their suitability with respect to specific biomedical applications, namely superhydrophilic and biofilm degrading implant surfaces. UV-induced hydrophilicity was quantified by static and dynamic contact angle analysis. Photocatalytic protein decomposition was analyzed by quartz crystal microbalance with dissipation. The surfaces were characterized by X-ray diffraction, atomic force microscopy, scanning electron microscopy and X-ray photoelectron spectroscopy. The radical formation on anatase, responsible for photocatalytic effects, was analyzed by electron spin resonance spectroscopy. Results have shown that the nanocrystalline anatase films, in contrast to reference titanium surfaces, were sensitive to UV irradiation and showed rapid switching towards superhydrophilicity. The observed decrease in carbon adsorbents and the increase in the fraction of surface hydroxyl groups upon UV irradiation might contribute to this hydrophilic behavior. UV irradiation of anatase pre-conditioned with albumin protein layers induces the photocatalytic decomposition of these model biofilms. The observed degradation is mainly caused by hydroxyl radicals. It is concluded that nanocrystalline anatase films offer different functions at implant interfaces, e.g. bedside hydrophilization of anatase-coated implants for improved osseointegration or the in situ decomposition of conditioning films forming the basal layer of biofilms in the oral cavity.

Regions with different evoked frequency band responses during early-stage visual processing distinguish mild Alzheimer dementia from mild cognitive impairment and normal aging.

Although diagnostic procedures have been developed for detection of mild cognitive impairment (MCI) and mild Alzheimer dementia (AD), more valid noninvasive tools are needed. In this work, we apply a procedure based on the evidences that different evoked frequency band responses may emerge from different sources during early-stage visual processing in a mental state-specific manner, while subjects were passively viewing a visual stimulus. In this case, spatial differences should arise across mental conditions such as mild Alzheimer dementia, mild cognitive impairment, and normal aging. With the use of EEG source image we found three different neural patterns in aged individuals: (1) left hippocampus and midbrain in mild AD, (2) left lateral orbitofrontal gyrus, left nucleus accumbens, caudate nucleus, thalamus, posterior cinguli, right precuneous, right superior parietal lobe in MCI, and (3) right lateral-medial orbitofrontal gyrus, caudate nucleus, thalamus, right lateral occipitotemporal gyrus in elderly controls. Although preliminary, these results show remarkably robust differences that distinguish between an age-matched control group, a group with MCI, and a group with mild AD. Because the method applied in this work differentiates among clinical entities with varying severity of cognitive decline, it may eventually serve as an electrophysiological marker in the early detection of neurodegeneration.

Combining metabolic engineering and metabolic evolution to develop nonrecombinant strains of Escherichia coli C that produce succinate and malate.

Derivatives of Escherichia coli C were engineered to produce primarily succinate or malate in mineral salts media using simple fermentations (anaerobic stirred batch with pH control) without the addition of plasmids or foreign genes. This was done by a combination of gene deletions (genetic engineering) and metabolic evolution with over 2,000 generations of growth-based selection. After deletion of the central anaerobic fermentation genes (ldhA, adhE, ackA), the pathway for malate and succinate production remained as the primary route for the regeneration of NAD+. Under anaerobic conditions, ATP production for growth was obligately coupled to malate dehydrogenase and fumarate reductase by the requirement for NADH oxidation. Selecting strains for improved growth co-selected increased production of these dicarboxylic acids. Additional deletions were introduced as further improvements (focA, pflB, poxB, mgsA). The best succinate biocatalysts, strains KJ060(ldhA, adhE, ackA, focA, pflB) and KJ073(ldhA, adhE, ackA, focA, pflB, mgsA, poxB), produce 622-733 mM of succinate with molar yields of 1.2-1.6 per mole of metabolized glucose. The best malate biocatalyst, strain KJ071(ldhA, adhE, ackA, focA, pflB, mgsA), produced 516 mM malate with molar yields of 1.4 per mole of glucose metabolized.

[Combined medical treatment and psychotherapy in early-stage Alzheimer's over a period of 30 months]. / Kombinierte pharmakologische und psychotherapeutische Behandlung im frühen Stadium einer Alzheimer-Demenz über 30 Monate.

The present case delineates the results of a 30-month combined pharmacological and psychotherapeutic treatment in a mildly to moderately depressed patient with early Alzheimer's dementia. At onset and during following visits, clinical examination and standardized test procedures for measuring cognitive and emotional changes were completed. Treatment results reveal a consistent benefit to cognitive levels and emotional distress over time. The present example of a mildly demented, depressed Alzheimer's patient shows a therapeutic outcome which is markedly superior to usual expectations in Alzheimer's treatment and encourages combination of therapeutic strategies in early stages of the disease.

Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study.

OBJECTIVE: To evaluate a novel specific psychological intervention aimed at improving coping in patients with systemic lupus erythematosus (SLE). METHODS: 34 community living SLE patients were recruited for the study. Intervention was undertaken in groups of up to eight patients and in two blocks over six months each. Eight patients were enrolled as a waiting list group. The 18 group sessions focused on information about the disease and specific problems of SLE patients, combining psychoeducative and psychotherapeutic elements. Psychological and medical evaluations were conducted at baseline and after three, six, and 12 months, using validated instruments. RESULTS: The 34 SLE patients (91% female, mean age 42 years) improved significantly over a six month period on most of the psychological measuring instruments applied, such as depression, anxiety, and overall mental burden. The waiting list group showed no significant changes. CONCLUSIONS: Conceptualised psychoeducational support may produce a significant and sustained improvement in coping skills of SLE patients and hence in their quality of life.

[Treatment of Alzheimer's disease utilising the best available evidence-based medicine -- utopia?]. / Therapie der Alzheimer-Demenz mit der besten verfügbaren Evidenz -- eine Utopie?

STUDY OBJECTIVES: To practice evidence-based medicine is considered to improve health care, particularly of chronically ill patients. Taking Alzheimer's as an example the objective of this study is to explore as to how far ambulatory Alzheimer's patients receive the medical treatment with the best evidence available. METHOD: In 2000 and 2002 the health care situation of Alzheimer's disease patients was assessed by conducting telephone interviews with one hundred randomly selected general practitioners and specialists listed in the panel of the Institut fur Medizinische Statistik (IMS -- Institute for Medical Statistics). By means of a standardised questionnaire the interviewees' prescriptions were assessed as well as their knowledge of the medical therapy for Alzheimer's and the use of non-medical therapeutic measures. Besides, the interviewees' prescriptions were checked on the basis of quantitative data taken from the IMS panel. Cholinesterase inhibitors (ChE-I), which are accorded the best evidence presently available in the medical treatment of Alzheimer's, were seen as a marker for the improvement of health care in the course of the study. RESULTS AND CONCLUSIONS: The interviewed physicians considered the evidence of medical Alzheimer's disease therapy with cholinesterase inhibitors high. 67 % of the interviewees would use ChE-I as the drug of first choice if a near relative fell ill with Alzheimer's. However, the ChE-I prescriptions were limited to 13 % in the base year 2000 and to 24 % in the base year 2002. Obviously, the implementation of this medical therapy is hampered by budgetary regulations. The interviewees find it particularly disadvantageous that the prescription of ChE-I may overstrain the budgets allocated to their practices. As a consequence, the effort to improve the quality of health care by implementing evidence-based medicine is thwarted by the increasing pressure on German physicians to prescribe drugs according to economic viability.

[Psychiatric disorders in rheumatic diseases, as exemplified by systemic lupus erythematosus (SLE)]. / Psychische Störungen bei rheumatischen Erkrankungen am Beispiel des Systemischen Lupus Erythematodes (SLE).

Among the rheumatic diseases, systemic lupus erythematosus (SLE) reveals the highest frequency of central nervous symptoms. Psychiatric abnormalities are present in over 90% of the patients, if very mild cognitive impairment is included. The psychiatric syndromes listed by the American College of Rheumatologists encompass cognitive syndromes, including the acute confusional state, anxiety disorders, depressive symptomatology and psychosis. Associations between cognitive impairment and demographic and disease variables, i. e. disease severity, have not been clearly identified so far. The same holds true for the evolution of depressive symptoms. Reactive depression in coping with a chronic disease is, however, a psychologically plausible factor in addition to specific cerebral lesions. Therapeutic interventions in SLE should consist of a combined pharmacological and nonpharmacological treatment. Corticosteroid drugs, however, may be effective in alleviating mild psychiatric symptoms as well.